Abstract:
Background: Tuberculosis (TB) remains a public health problem, particularly in people living
with human immunodeficiency virus (PLHIV). Yet, efforts to reduce TB incidence using
isoniazid preventive therapy (IPT) have been curtailed by poor uptake of this intervention.
This study reviewed the rate of IPT initiation in the sub-Saharan country of Lesotho, which has
one of the highest TB incidences in the world.
Methods: Time to IPT initiation in randomly sampled medical records of PLHIV was analysed
using Cox’s proportional hazards regression. Differences in the periods of enrolment into
Human immunodeficiency virus (HIV) care were controlled for by considering the year IPT
was launched (2011) as the base year and stratifying the medical records into the 2004–2010
cohort (before the launch of IPT) and the 2011–2016 cohort (after the launch).
Results: Out of 2955 patients included in the final analysis, 68.8% had received IPT by the
study exit time. However, the overall rate of IPT initiation was 20.6 per 100 person-years, with
135 (6.6%) treatment interruptions. Compared to the 2004–2010 cohort, the 2011–2016 had a
significantly (p < 0.05) higher rate of initiation (15.8 vs. 27.0 per 100 person-years, respectively).
Age group, district category and duration of antiretroviral therapy emerged as the most
significant predictors of IPT initiation, while district category and gender significantly
predicted IPT therapy interruption.
Conclusion: These findings indicate a high uptake of IPT with a slow rate of implementation.
Significant factors associated with disparities in the initiation and interruption of IPT therapy
in this study are important for policy review.
